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Biomedical subjects

S Jarnum

Publications and source records attributed to S Jarnum.

At least 55 records · Page 3Linked to original sources
PubMed1984

'Microerosions' in rectal biopsies in Crohn's disease.

Small (less than 1 mm), superficial erosions ('microerosions') have been observed stereo-microscopically in surface-stained rectal biopsies in Crohn's disease (CD). Biopsy specimens from 97 patients with CD, 225 with ulcerative colitis (UC), and a control material of 161 patients were investigated to define the occurrence and significance of the microerosions. In CD they were found in 13% of specimens, in UC in 5%, and in the control material not at all. In CD they were observed only in patients with colonic involvement and were most frequent (44%) in patients with this site of affection exclusively. Granulomas were identified in 62% of the biopsies with microerosions and by examination of two consecutive biopsies from each of these patients, in 85% indicating a positive correlation. In patients with microerosions and a primary diagnosis of UC, granulomas were found in 38% and by examination of two biopsies in 54%. Patients with granulomas and a few other patients were reclassified as CD, but there still remained some patients with microerosions, who most probably had UC. In conclusion, microerosions are observed mainly in CD with colonic involvement. There is a high incidence of granulomas in biopsy specimens with microerosions. The demonstration of microerosions in a specimen is suggestive of, but probably not diagnostic of, CD.

Biopsy↗
PubMed1984

Pregnancy in Crohn's disease.

Over a 13-year period, the course of 109 pregnancies in 68 women with Crohn's disease was studied. A total of 76 children were delivered. There were no gemellary deliveries, and none of the children had congenital malformations. Pregnancy entailed no increased risk of an exacerbation of the bowel disease. As compared with the reference population and with women with ulcerative colitis, the total material showed an increased risk of premature delivery and spontaneous abortion, but a further analysis showed that this was due only to an increased risk in women with active disease at the time of conception and in women who had undergone bowel resection during pregnancy. Birth weight and birth length corresponded to those in the reference population. The frequency of neonatal hyperbilirubinaemia was not higher in children of mothers with Crohn's disease than in children of healthy mothers. Treatment with sulphasalazine, salazosulphadimidine, and corticosteroids did not influence the course of pregnancy or the frequency of neonatal jaundice or malformations. Consequently, in Crohn's disease a pregnant woman should be given the same medical treatment as when not pregnant. Generally, the women should be advised preferably to conceive at a time when their bowel disease is inactive. The risk groups should be followed up with frequent obstetrical examinations throughout pregnancy.

Abortion, Spontaneous↗
PubMed1983

Pregnancy in ulcerative colitis.

The course of pregnancy in 97 women with ulcerative colitis was studied over a 12-year period. During this period they had 173 pregnancies and delivered 136 children. There were two gemellary deliveries. Nine women had a spontaneous and 16 an induced abortion, of which 4 were performed on therapeutic indication. For a woman with ulcerative colitis the risk of an exacerbation of the bowel disease was 32% per year in her fertile years, whereas it was 34% per year during pregnancy. This difference is not statistically significant. As compared with women with an inactive bowel disease, women in whom the disease was active at the start of pregnancy had a small but significantly greater risk of spontaneous abortion and premature delivery. The frequency of malformations, prematurity, and neonatal hyperbilirubinaemia was not higher in the children of ulcerative colitis mothers than in those of healthy mothers. Treatment with sulphasalazine, salazosulphadimidine, and corticosteroids had no influence on the course and outcome of pregnancy. Birth length and weight of the children of mothers with ulcerative colitis equalled those for children of healthy mothers. In conclusion, pregnancy does not necessitate any change in the usual medical treatment of ulcerative colitis. Women with ulcerative colitis should be advised preferably to conceive at a time when their bowel disease is inactive. Generally, ulcerative colitis constitutes no indication for induced abortion.

Abortion, Induced↗
PubMed1982

Fructose, xylitol and glucose in total parenteral nutrition.

A comparison was made between isocaloric amounts of 24% glucose and 24% Triofusin (composed of 120 g fructose, 60 g glucose and 60 g xylitol per liter) during the course of a 6-day, 3-phase crossover study of 15 patients undergoing total parenteral nutrition. The patients received a total of 0.5 g carbohydrate per kg per day. Plasma glucose as significantly higher during glucose infusion (7-22 mmol/l, median: 9 mmol/l,) than during Triofusin infusion (5-16 mmol/l, median: 6 mmol/l). A moderate to severe glucosuria was detected in three patients during infusion of 24% glucose, and this declined considerably during the Triofusin period. The total renal carbohydrate loss during the glucose period was 0-143 g, median: 6 g per day, and during the Triofusin period was 6-68 g, median: 10 g per day. The nitrogen balance and carbamide production rate were the same in the two infusion regimes. Changes in biochemical liver parameters were observed in most of the patients, but these could not be attributed to parenteral nutrition. None of the patients developed symptoms of metabolic acidosis. There was a slightly but significantly higher urinary excretion of oxalate in the Triofusin period (0.1-1.1 mmol per day, median: 0.5 mmol per day) than in the glucose period (0.1-1.0 mmol per day, median: 0.4 mmol per day). Most of the patients exhibited a slightly increased urinary excretion of urate, irrespective of the infusion regimen. Serum urate remained normal. It was concluded that Triofusin infused in the described dosage is a suitable calorie source for parenteral nutrition, but that it does not present a distinct advantage over the use of pure glucose solution. In patients suffering from reduced glucose tolerance, however, Triofusin represents a more easily manageable calorie course.

Adult↗
PubMed1982

Effects and side-effects of partial ileal by-pass surgery for familial hypercholesterolaemia.

Ten patients with familial hypercholesterolaemia were subjected to partial ileal by-pass surgery. Plasma cholesterol fell by 41 and 38% and low-density lipoprotein cholesterol by 51 and 46% after six and 18 months respectively. High-density and very low-density lipoprotein cholesterol and plasma triglycerides were unaffected. Alanine aminotransferase increased transiently in half of the patients. Diarrhoea and slight steatorrhoea troubled most of the patients for the duration of 18 months' period of observation. Other long-term side effects were slight but significant increase in the renal excretion of oxalic acid and reduction in the intestinal absorption of calcium. The study shows that this operation has metabolic side-effects that warrant continued medical care of these patients.

Adult↗
PubMed1981

Long-term parenteral nutrition. I. Clinical experience in 70 patients from 1967 to 1980.

Seventy patients, 37 females and 33 males, median age 46 years, have been treated with long-term parenteral nutrition for 816 patient-months, or 68 patient-years. Short-bowel syndrome was the commonest indication for parenteral nutrition (582 patient-months). Twenty-four patients were receiving home parenteral nutrition. Most had severe short-bowel syndrome following intestinal resection for Crohn's disease or mesenteric infarction. Metabolic complications included zinc deficiency syndrome in four patients before routine zinc administration and progressive halisteresis in five patients. The mortality for 26 patients with short-bowel syndrome was 23%, for 15 patients with intestinocutaneous fistulas 40%, and for 15 patients with severe emaciation for various causes 27%. Parenteral nutrition was withdrawn in 6 (23%) of the 26 patients with short-bowel syndrome, who subsequently were able to maintain body weight with oral feeding. Fifteen patients are still (February 1980) receiving home parenteral nutrition.

Adolescent↗
PubMed1981

Long-term parenteral nutrition. II. Catheter-related complications.

Catheter-related complications were investigated in 70 patients receiving long-term parenteral nutrition (LTPN) for 1 to 63 months (median, 4.5 months) with a total observation period of 816 patient-months. Two hundred and three central venous catheters were used: 52 Broviac silicone rubber catheters and 151 Intracaths or Argyle baby feeding tubes made from polyvinyl chloride with plasticizers. The median duration was longer for Broviac catheters (5.0 months) than for the other catheters (1.1 months). Pneumothorax and/or subcutaneous emphysema occurred in 14 of 113 subclavian vein punctures (12%). Forty-eight episodes of catheter sepsis occurred in 27 patients. The incidence of sepsis was lower for Broviac catheters (0.3 per catheter-year) than for the other catheter types (0.9 per catheter-year). Catheter-induced thrombosis of a central vein was shown by phlebography 35 times among 25 (52%) of te 48 patients investigated, corresponding to an overall incidence of 1 in 22 patient-months. Total occlusion of a central vein occurred in 14 cases. The incidence of thrombosis was lower for Broviac catheters (0.5 per catheter-year) than for the other catheters (1.6 per catheter-year). Partial venous occlusions usually resolved after heparin therapy and/or catheter exchange, whereas total occlusions usually persisted for years. No correlation was found between incidence of complications and catheter lifetime. Seventeen patients died while receiving LTPN. In three patients death was related to LTPN: catheter sepsis, subdural haematoma possibly due to anticoagulant therapy, and respiratory failure caused by pulmonary infection after iatrogenic pneumothorax. For LTPN we recommend Broviac catheters, which showed longer duration, lower complication rate, and higher patient compliance. Catheter sepsis should be treated with both catheter exchange and antibiotics. Because of the high incidence of thrombosis we recommend that all patients on LTPN receive anticoagulant therapy. However, the value of anticoagulant therapy is not proved in a prospective, controlled study.

Adolescent↗
PubMed1980

Melkersson-Rosenthal syndrome and Crohn's disease.

Identical clinical and histopathological features of the oro-facial swellings in Melkersson-Rosenthal syndrome (M.R.S.) and Crohn's disease (C.D.) exist. In order to disclose a possible relation between these two granulomatous diseases and to evaluate the necessity of extensive screening for C.D. in cases of M.R.S., 16 patients with complete or abortive forms of M.R.S. were examined. However, no clinical, radiological or biochemical findings indicated such a relationship. It is concluded that in patients with M.R.S. extensive examinations for C.D. are not justified in absence of associated gastrointestinal symptoms.

Adolescent↗
PubMed1980

The importance of the colon in calcium absorption following small-intestinal resection.

The importance of the colon for the absorption of calcium, fat, and fluid was studied in 118 patients with small-bowel resections of various lengths. The patients fell into two groups: 38 with ileostomy and 80 with part of or the whole colon in function. In patients with ileostomy, but not in patients with the colon preserved, the absorption of 47Ca and fluid was inversely correlated to the length of the resected small intestine. In patients with extreme small-bowel resection (greater than or equal to 150 cm) the 47Ca absorption was significantly higher when colon was preserved. In groups of equal small-bowel resections stool mass was significantly higher in patients with ileostomy, but faecal fat was not. However, in both groups faecal fat was correlated to the length of the resected small bowel. The study shows that colon plays an important role for the absorption of calcium after small-intestinal resection and confirms the importance of colon for fluid absorption.

Adolescent↗
PubMed1980

Calcium treatment of enteric hyperoxaluria after jejunoileal bypass for morbid obesity.

The effect of oral calcium on oxalate absorption was studied in eight patients with secondary hyperoxaluria after jejunoileal bypass for morbid obesity during a standardized diet with a fixed supply of fat, calcium, and oxalate. A supplementary calcium dose of 2000 mg/day reduced renal oxalate excretion from 119 to 60 mg/24 h (median values, p < 0.01). Correspondingly, 14C-oxalate absorption decreased from 28% to 9% (p < 0.01). No statistically significant increase in urinary calcium was observed. The study shows that renal oxalate excretion in patients with enteric hyperoxaluria can be reduced by oral calcium. However, we doubt that it has any practical, clinical importance.

Adolescent↗